ABSTRACT
The operative treatment of subcortical metastatic tumors within the central and paracentral area is still under discussion. Against the background of possible new postoperative neurological deficits and of evolving new radio oncological techniques, the indication for surgery is limited only to a subgroup of patients. To present the clinical results after operative treatment of metastases within the central and paracentral brain regions, with an emphasis on the short-term and midterm functional outcome. This study was carried out in the period between January 2007 and January 2011 in the neurosciences hospital in Baghdad, Iraq. The prerequisite inclusion criteria for the patients to be included in this study were: A contrast enhanced CT and/or MRI showing a secondary lesion in the central or paracentral regions of the brain. The patient has a known primary tumor source with a confirmed histopathological diagnosis. The postoperative histopathological result of the removed brain tumor correlates with the histopathology of the primary tumor. A stable extra cerebral tumors dissemination controlled by a systemic oncological therapy and an estimated life expectancy of more than 6 months. If the patient did not have, even one, of the above criteria he or she has not been included in this study. The Karnofsky Performance Status [KPS] was used to measure the patients' functional ability. The Functional Assessment of Cancer Therapy-Brain [FACT-Br] determines various quality of life [QOL] aspects in brain tumors patients. On a 54-item scale patients respond from 0 [not at all] to 4 [very much]. With the FACT-Br five major components of QOL are assessed: physical, social, emotional, functional well-being, patient-physician relationship and other activities of daily life [ADLs]. Tumor localization and its extension were defined on preoperative gadolinium-enhanced T1-weighted MRI-scans. Additional information was gained from T1-, and T2- scans, which were done in all patients. After updated MRI those patients were evaluated for surgery. Early postoperative control was done by MRI within the first 10 days. Follow-up took place in the outpatient department, assessing clinical criteria 2 and 6 weeks postoperatively, followed by clinical control and MRI-scans every 3 months. In all patients, surgery was performed under general anesthesia. 20 patients suffering from subcortical brain metastases within the primary sensori-motor area, with a median volume on MRI-scans of 8.18 cm. Patients were admitted to the hospital with a progressive hemiparesis [n - 11], focal seizures [n = 6] or other unspecific symptoms [n = 3] like headache, nausea, and neuropsychological disturbances, respectively. Surgery and the early postoperative course were uneventful in all cases. After a 6-month follow-up, two patients had died. The motor deficits improved in I seven patients and remained unchanged in four cases. One patient suffered from a new persistent hemiparesis. A temporary paresis occurred in two cases. In five patients there was no motor deficit pre- and postoperatively. The KPS improved in ten patients 6 months after surgery. Quality of life, measured by the FACT-Br score, improved in 12 patients and remained unchanged in one patient. Even preexistent deficits can improve with positive influence on the quality of life for oncological patients, being disabled by the symptoms caused by the cerebral lesion